Children diagnosed with cancer are more likely than ever before to survive the disease, but with a potential new set of health problems caused by the cancer treatment itself. Those problems can particularly affect the heart, and as doctors and other health care workers try to assess how best to care for this special population, City of Hope researchers are providing guidance.

More people are surviving childhood cancer, but finding they have unique health problems in adulthood. City of Hope researchers are offering guidelines on how to monitor survivors' health.

Scientists from the Childhood Cancer Survivorship Clinic at City of Hope led an international effort to complete a comprehensive review of all available literature and make meaningful recommendations on how to protect the hearts of childhood cancer survivors. The recommendations are needed. Cardiovascular complications – coronary artery disease, stroke and congestive heart failure – have emerged as a leading cause of illness and death in adult survivors of childhood cancer.

“We’re ending a new era in survivorship care delivery,” said first author Saro Armenian, D.O., M.P.H., director of the Childhood Cancer Survivorship Program at City of Hope. “This collaboration allowed us to draw on international expertise for a critical review of the available data, identify research priorities and make some recommendations.”

The main recommendation from the study is that those survivors treated with high doses of anthracyclines – a common chemotherapy drug – or high doses of chest radiation, or a combination of both, should undergo lifelong surveillance for cardiomyopathy, that is, a deterioration in the heart muscle. Patients treated at moderate or low doses should also be considered for surveillance, depending on other risk factors.

The researchers recommended echocardiography as the primary method of surveillance, though other forms of screening could also be considered, such as MRI (magnetic resonance imaging). They suggested that screening begin within two years of completing therapy, and repeated every five years, though more frequent testing is reasonable for those at higher risk.

Saro Armenian (Photo by Walter Urie)

“Childhood cancer survivors, regardless of current age, should be aware of their increased risk of cardiovascular risk,” Armenian said. “This is a lifelong risk, so surveillance and monitoring must be lifelong. Many of these problems don’t manifest until 10 or 20 years after treatment is done.”

Childhood cancer survivors should also be especially careful to manage their risk of high blood pressure and diabetes, both of which create additional risk of heart disease.

The researchers hope the latest study will help increase awareness about how to monitor childhood cancer survivors. After all, such assessment is uncharted territory for many physicians, because childhood cancer survivors reaching their 50s and 60s is a fairly new phenomenon.

But uncharted doesn't mean unneeded. Although treatment advances can now keep about 80 percent of childhood cancer patients alive for at least five years, more than 40 percent of childhood cancer survivors who are still alive 30 years after their diagnosis have a severe or life-threatening chronic health disorder.

If potential heart problems can be identified early, then there’s a chance to mitigate them.